COVID-19 plasma treatment: Everything you need to know
From left: A bag of plasma; the arm of COVID-19 survivor and Sen. Juan Miguel Zubiri is seen during the process of plasma donation.
Philippine General Hospital/Released
COVID-19 plasma treatment: Everything you need to know
Ratziel San Juan (Philstar.com) - April 25, 2020 - 10:22am

MANILA, Philippines (First published on April 24, 2020, 6:28 p.m.) — With still no approved treatment or available cure to treat life-threatening cases of novel coronavirus disease 2019 (COVID-19), doctors at the Philippine General Hospital (PGH) are turning to convalescent plasma therapy, a key investigational treatment that has been around since the 1890s.

“Filipinos continue to suffer and some eventually die from COVID-19 every day. There is no proven treatment yet for this, although different medications and regimens are being investigated. And the vaccine against the novel coronavirus is not yet available,” lamented PGH spokesperson doctor Jonas del Rosario.

“That is why we are calling for plasma donations from COVID-19 survivors. Their antibodies may help save patients who are still battling the disease, especially the severe and critical cases.”

Getting antibody-rich plasma from disease survivors to boost the immune system of currently-afflicted patients has proved vital in fighting outbreaks like the 1918 Spanish Flu to the more recent swine flu pandemic in 2009.

With scores of patients at death’s door, PGH is calling on the 762 who have recovered from the coronavirus to help its admitted cases stand a chance at survival by donating much-needed blood plasma.

Here’s what you need to know about the plasma treatment, as answered by Del Rosario during yesterday’s virtual briefing “From survivor to hero, helping those still battling the disease.”

How does convalescent plasma therapy work?

The immune system of those who contracted the coronavirus developed antibodies against it. These virus-fighting agents are found in the liquid part of the blood known as plasma.

COVID-19 survivors can donate their blood in order to extract the antibody-rich plasma, which would then be transfused to currently-infected patients to boost their immune system and possibly boost their recovery.

How is it done?

The PGH has issued a call to all COVID-19 recovered patients to donate their blood. Survivors, however, would still need to signify their intention to help by calling the appropriate hotlines.

They may contact either doctor Sandy Maganto at 0917-805-3207 or the PGH Hotline at 155-200.

During the telephone conversation, they will be screened to check if they are eligible to donate based on certain criteria.

If approved, PGH personnel will visit the interested donor’s house where the team would collect blood sample. This will be sent to their lab to be checked for infection and other factors.

If the COVID-19 survivor passes the initial screening, he or she will finally be invited to donate blood at a facility in the University of the Philippines College of Medicine.

“You then undergo what we call plasmapheresis wherein your blood, you’re going to be donating blood but only the plasma will be taken away... and then that plasma will then be examined and tested, and then it will be stored in a refrigerator. Sometimes for a few hours, especially if we already have a recipient ready, or sometimes a few days until we get someone who is needing it,” Del Rosario said.

Under current hospital protocol, only patients who are severely or critically ill are allowed to be plasma recipients as a last resort.

“We then observe, of course, the clinical course of the patient who got it. Tignan namin ‘yung ano ba ang kanilang course, nagkaroon ba ng side effects, gumanda ba ang kalagayan nila, was there an improvement, were we able to take them out of the ICU, all of those things,” Del Rosario said.

The best-case-scenario the hospital is hoping for is that patients who survive thanks to plasma treatment would eventually become donors themselves upon recovery.

Who can donate blood?

Interested donors must be confirmed, fully-recovered COVID-19 survivors with at least one negative polymerase chain reaction (PCR) test and who have not exhibited any symptoms of the coronavirus for at least two weeks.

They would also need to weigh at least 50 kilograms and provide their informed consent for the procedure.

“For a donor to be a good donor, first of all, we have to make sure, we will interview you. We will have to confirm that indeed you had COVID-19. Dapat po nagkasakit kayo (You need to have been infected),” Del Rosario said.

“Now, objectively, the best proof that you had COVID-19 is a positive RT-PCR test.”

This means the willing donor at one point had nasopharyngeal and oropharyngeal swab, had their sample collected and ran in a PCR lab before returning a positive result.

They would then need to be back to their “usual self,” examined and verified as healthy by a doctor.

“We have to get a little bit of your blood sample because we want to make sure that first, you are not anemic... Or you also have to make sure you do not have any of those viral, bloodborne infections like hepatitis, HIV, malaria, syphilis.”

How often can qualified survivors donate blood?

Survivors who donate plasma specifically can do so every two weeks, compared to normal blood donations which require two to three-month waiting periods in between.

When is the right time to use plasma therapy?

Timing varies but under PGH protocol, plasma is infused into a COVID-19 patient within the third to 21st day of illness. Beyond that is considered dangerous and "too late."

Can mild or asymptomatic cases also receive plasma treatment?

“Someone who has a very mild disease... can this be something that could be given to the patient like that so that they won’t progress... that’s actually something that we’re hoping that will happen also,” Del Rosario said.

Have side effects been observed?

According to Del Rosario, none of the six plasma recipients in PGH developed adverse reactions like dust allergy, fever or lung injury or volume overload.

How many have donated plasma so far?

Of the 60 who have signified intention to donate, 21 have passed the screening with 19 able to donate so far.

How many were treated by these plasma donations? What is their current condition?

PGH had six recipients, while the Asian Hospital in Muntinlupa had two and the Manila Doctors Hospital had one.

Four of the PGH recipients are "doing well" with one out of the ICU and currently recovering. The other two, however, expired.

The Asian Hospital beneficiaries are reportedly stable, but the Manila Doctors Hospital recipient was the late Sen. Heherson Alvarez who passed away Monday.

Is there an age limit for donors?

Younger COVID-19 survivors are preferred.

Ideal donors are pegged at less than 60 “because most of the time, these donors who are in the senior population, they have comorbidities which eventually will exclude them from donating like heart disease, diabetes which is uncontrolled, severe hypertension, recovered from malignancy.”

Will pregnancy be factored in for donors?

It's a "plus" if interested female donors have not yet given birth. The PGH is particularly looking for nulliparous women or those who have never had a child.

What is the success rate of the plasma treatment so far?

"About a little bit over 50% batting average. We’re still hopeful because to tell you frankly, there’s no approved treatment for COVID-19."

Do patients need to pay for plasma treatment? If so, how much would it cost?

Plasma treatments are free at PGH, but Del Rosario said they cannot speak for other hospitals. 

These are also not covered by PhilHealth since plasma therapy is "not yet a standard of care" because it's an experimental treatment.

Does the blood type of the donor and recipient need to be the same?

Yes. "That’s why we also need a lot of donors because as you know it has to be blood-type specific."

How long does the donation procedure take?

It depends on how big the vein is but these usually range from 45 minutes (big veins) up to two hours (relatively smaller veins).

COVID-19 NOVEL CORONAVIRUS PGH PHILIPPINE GENERAL HOSPITAL
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